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Michael Setiawan
Bagian Neurologi RS Pluit, RSPI Puri Indah, Jakarta, Indonesia
Health Professions Medicine & Pharmacology Public Health

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Paraneoplastic Limbic Encephalitis: Pendekatan Diagnosis dan Penatalaksanaan Michael Setiawan
Cermin Dunia Kedokteran Vol 41, No 1 (2014): Neurologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v41i1.1171

Abstract

Paraneoplastic limbic encephalitis (PLE) merupakan entitas yang termasuk dalam paraneoplastic neurological syndromes (PNS), berhubungan dengan beberapa jenis tumor, disebabkan oleh gangguan sistem imun yang dicetuskan oleh ekspresi aberan antigen onkoneural tumor. Dalam beberapa dekade ini sudah diidentifikasi sejumlah antibodi yang berkaitan dengan PLE yaitu antibodi onkoneural klasik terhadap antigen intraseluler, dan antibodi terhadap antigen permukaan sel. Masing-masing antibodi memberikan karakteristik gejala klinis, gambaran magnetic resonance imaging (MRI), dan respon pengobatan yang berbeda. Gambaran klinis khas adalah onset subakut atau akut gangguan memori jangka pendek, gejala psikiatrik, dan kejang. Walaupun spektrum klinis belum sepenuhnya diketahui, sindrom klinis PLE penting dikenali karena dapat memberikan respon terhadap imunoterapi. Secara umum, pasien dengan antibodi terhadap antigen permukaan sel prognosisnya lebih baik karena perjalanan klinisnya cenderung tidak terlalu berat, dan memberikan respons baik dengan terapi imunomodulasi.Paraneoplastic Limbic Encephalitis (PLE) is an entity belonging to Paraneoplastic Neurological Syndromes (PNS), associated with several tumors, caused by immune mediated disorders triggered by aberrant expression of onconeural antigens in the tumor. In the last few decades, 2 groups of antibodies associated with PLE have been identified, classical onconeural antibodies directed against the intracellular antigens, and surface antigen antibodies. Each antibody gives characteristic clinical manifestations, magnetic resonance imaging (MRI) findings, and different response to therapy. Characteristic clinical manifestations are subacute or acute onset of recent memory loss, psychiatric manifestations, and seizures. Although the clinical spectrum has not yet been fully investigated, the clinical importance lies in their good response to immunotherapies. Generally, patients with surface antigen antibodies have more favorable prognosis because the clinical course tends to be less severe, and respond well with immunomodulation treatment.
Komplikasi Neurologis Endokarditis Infektif Michael Setiawan
Cermin Dunia Kedokteran Vol 42, No 5 (2015): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v42i5.1011

Abstract

Endokarditis infektif (EI) dapat mengakibatkan komplikasi neurologis yang berat dan mengancam nyawa. Komplikasi neurologis kebanyakan terjadi akibat emboli septik yang menyebabkan iskemia atau proses peradangan, sehingga mengakibatkan infark serebri, perdarahan, meningitis atau abses otak. Gambaran klinis bervariasi tergantung bagian otak yang terkena. Diagnosis komplikasi neurologis EI harus dipikirkan pada pasien usia muda dengan hemiplegi akut dan demam. Diagnosis ditegakkan dengan anamnesis dan pemeriksaan fisik yang teliti, kultur darah, pemeriksaan neuroimaging, dan echocardiography. Penatalaksanaan EI adalah dengan antibiotik untuk eradikasi bakteri. Pengobatan emboli serebral dengan antitrombotik sampai saat ini masih kontroversial. Prognosis buruk, terutama pada perdarahan otak dan disfungsi neurologis berat.Infective endocarditis (IE) can have devastating and life-threatening neurological complications. Neurological complications are ischemia or inflammation most often due to septic embolization, resulting in cerebral infarction, hemorrhage, meningitis, or brain abscess. Clinical findings vary according to the affected part of the nervous system. The diagnosis should be suspected in febrile young patient with acute onset hemiplegia. Diagnostic measures should include a careful history and physical examination, blood cultures, neuroimaging and echocardiography. Treatment of IE relies on microbe eradication by antimicrobial drugs. The proper use of antitrhombotic therapy in cerebral emboli is still controversial. Outcome is poor, especially in patients with brain hemorrhage and severe neurological dysfunction.
Reversible Cerebral Vasoconstriction Syndrome : Kegawat-daruratan Neurologis dengan Gejala Nyeri Kepala Hebat Michael Setiawan
Cermin Dunia Kedokteran Vol 41, No 7 (2014): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v41i7.1122

Abstract

Reversible cerebral vasoconstriction syndrome merupakan salah satu penyebab nyeri kepala akut berat yang penting dan potensial mengancam jiwa. Sindrom yang makin banyak dikenali ini mempunyai gejala karakteristik nyeri kepala hebat (thunderclap headache) berulang, dengan atau tanpa defisit neurologis; pada pemeriksaan angiografi dijumpai vasokonstriksi segmental pembuluh darah otak yang membaik dalam 3 bulan. Hampir 80% penderita memiliki faktor presipitasi. Sindrom ini sering dijumpai pada wanita, berhubungan dengan kehamilan dan paparan terhadap beberapa jenis obat. Hiperaktivitas simpatis mungkin berperan besar pada patogenesis RCVS. Untuk menegakkan diagnosis dibutuhkan gambaran karakteristik strings and beads pada angiografi serebral yang membaik dalam 3 bulan. Beberapa penelitian terbaru menunjukkan obat penyekat kanal kalsium seperti nimodipine mungkin efektif untuk pengobatan sindrom ini, sedangkan kortikosteroid mungkin merugikan. Sebagian besar pasien RCVS dapat pulih tanpa gejala sisa, rekurensi terjadi pada sebagian kecil pasien, beberapa pasien dilaporkan meninggal.Reversible cerebral vasoconstriction syndrome (RCVS) is an important cause of acute severe headache and potentially has dire life-threatening consequences. This increasingly recognised syndrome is characterised by recurrent severe headaches (thunderclap headache), with or without neurological deficits, and segmental constriction of cerebral arteries that resolves within 3 months. Up to 80% of sufferers have identifiable triggers. RCVS has clear female predominance, and is associated with pregnancy and exposure to certain drugs. The pathogenesis of RCVS remains unknown; sympathetic hyperactivity may play a role. Diagnosis requires demonstration of the characteristic ‘strings and beads' appearance on cerebral angiography with resolution within 3 months. Recent trials showed calcium channel blockers, such as nimodipine may be effective for RCVS, but corticosteroid appears to be harmful. Most RCVS patients recover without sequelae; however relapse has been reported in a small proportion of patients, and mortality has been noted in some case reports.
Mielopati Non Kompresif: Pendekatan Diagnosis Michael Setiawan
Cermin Dunia Kedokteran Vol 47, No 9 (2020): Neurologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v47i9.909

Abstract

Mielopati merupakan kondisi patologis medula spinalis yang mengakibatkan gangguan fungsi motorik, sensorik dan otonom. Mielopati dibagi dua jenis yaitu mielopati kompresif dan mielopati non kompresif. Mielopati non kompresif disebabkan oleh berbagai etiologi seperti infeksi, demielinisasi, vaskular, otoimun atau gangguan metabolik. Pada tatalaksana mielopati akut, prioritas utama adalah menentukan penyebab dengan magnetic resonance imaging (MRI). Mielopati kompresif yang merupakan kondisi gawat darurat, sebagian memerlukan penanganan bedah, sedangkan sebagian besar penatalaksanaan mielopati non kompresif dengan terapi medikamentosa.Myelopathy describes pathologic conditions of spinal cord resulting in loss of spinal motor, sensory, and autonomic function. Myelopathy can be divided into two broad categories of non compressive and compressive myelopathy. Non compressive myelopathy may result from infectious, demyelinating, vascular, autoimmune, and metabolic disorders. In acute myelopathy, the utmost priority is to exclude acute compressive cause by MR imaging. Some cases of compressive myelopathy presented as a neurological emergency are managed surgically, but vast majority of non compressive myelopathy are medically managed.
Mielopati Non-Kompresif: Pendekatan Diagnosis Michael Setiawan
Cermin Dunia Kedokteran Vol. 47 No. 7 (2020): Neurologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v47i7.593

Abstract

Mielopati merupakan kondisi patologis medula spinalis yang mengakibatkan gangguan fungsi motorik, sensorik, dan otonom. Mielopati dibagi dua jenis, yaitu mielopati kompresif dan mielopati non-kompresif. Mielopati non-kompresif disebabkan oleh berbagai etiologi seperti infeksi, demielinisasi, vaskular, autoimun, atau gangguan metabolik. Pada tatalaksana mielopati akut, prioritas utama adalah menentukan penyebab dengan magnetic resonance imaging (MRI). Mielopati kompresif yang merupakan kondisi gawat darurat, sebagian memerlukan penanganan bedah, sedangkan sebagian besar penatalaksanaan mielopati non-kompresif dengan terapi medikamentosa. Myelopathy describes pathologic conditions of spinal cord resulting in loss of spinal motor, sensory, and autonomic function. Myelopathy can divided into two broad categories of non-compressive and compressive myelopathy. Non-compressive myelopathy may result from infectious, demyelinating, vascular, autoimmune, and metabolic disorders. In acute myelopathy, the utmost priority is to exclude acute compressive cause by MR imaging. Some cases of compressive myelopathy presented as a neurological emergency are managed surgically, but vast majority of non-compressive myelopathy are medically managed.
Mielopati Non-Kompresif: Pendekatan Diagnosis Michael Setiawan
Cermin Dunia Kedokteran Vol 47 No 7 (2020): Neurologi
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v47i7.593

Abstract

Mielopati merupakan kondisi patologis medula spinalis yang mengakibatkan gangguan fungsi motorik, sensorik, dan otonom. Mielopati dibagi dua jenis, yaitu mielopati kompresif dan mielopati non-kompresif. Mielopati non-kompresif disebabkan oleh berbagai etiologi seperti infeksi, demielinisasi, vaskular, autoimun, atau gangguan metabolik. Pada tatalaksana mielopati akut, prioritas utama adalah menentukan penyebab dengan magnetic resonance imaging (MRI). Mielopati kompresif yang merupakan kondisi gawat darurat, sebagian memerlukan penanganan bedah, sedangkan sebagian besar penatalaksanaan mielopati non-kompresif dengan terapi medikamentosa. Myelopathy describes pathologic conditions of spinal cord resulting in loss of spinal motor, sensory, and autonomic function. Myelopathy can divided into two broad categories of non-compressive and compressive myelopathy. Non-compressive myelopathy may result from infectious, demyelinating, vascular, autoimmune, and metabolic disorders. In acute myelopathy, the utmost priority is to exclude acute compressive cause by MR imaging. Some cases of compressive myelopathy presented as a neurological emergency are managed surgically, but vast majority of non-compressive myelopathy are medically managed.
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